A One-day Acceptance and Commitment Therapy Workshop for the Prevention of Chronic Post-surgical Pain and Long-term Opioid Use Following Spine Surgery: Protocol for a Pilot Feasibility Randomized Controlled Trial

Overview

Journal Contemp Clin Trials

Publisher Elsevier

Date 2024 Dec 24

PMID 39719249

Authors

Jolin B Yamin

Bethany D Pester

Ramya Kommu

Caroline Allen

Diya Dharmendran

Kylie Steinhilber

Madelyn Crago

Savannah Kazemipour

Angelina Franqueiro

Delia Fentazi

Kristin L Schreiber

Robert R Edwards

Robert N Jamison

Samantha M Meints

Affiliations

Soon will be listed here.

Abstract

Background: Back pain is increasingly common, leading to more spine surgeries. While most people experience pain relief and improved function after surgery, many continue to suffer from chronic post-surgical pain (CPSP) with limited functional improvement. CPSP is often treated with opioids, raising concerns about misuse, poor functional outcomes, and broader public health impacts. Therefore, perioperative interventions are needed to enhance outcomes and reduce the risk of opioid misuse after surgery.

Objective: This article outlines a study protocol evaluating the feasibility, acceptability, and preliminary efficacy of a brief, perioperative Acceptance and Commitment Therapy (ACT) intervention aimed at improving pain and reducing opioid use after spine surgery.

Design: In this pilot randomized controlled trial, participants scheduled for spine surgery (anticipated N = 100) are assigned to the ACT intervention or a treatment-as-usual group.

Intervention: The ACT intervention is a 5-h, single-session, virtual workshop with a booster call two weeks post-workshop or post-surgery, whichever is later.

Outcome Measures: The primary outcome is patient-reported treatment helpfulness immediately after the intervention. Secondary outcomes include patient-reported treatment credibility and expectancy post-intervention, treatment helpfulness at 1 month post-surgery, and pain interference, pain intensity and opioid use at 1, 3, and 6 months post-surgery.

Conclusion: This pilot trial examines a novel, brief ACT intervention aimed at preventing CPSP and reducing opioid dependence. If successful, feasibility and preliminary efficacy results will be utilized to inform a future, full-scale randomized trial of this intervention.

References

Veehof M, Trompetter H, Bohlmeijer E, Schreurs K . Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther. 2016; 45(1):5-31. DOI: 10.1080/16506073.2015.1098724. View

Jancuska J, Hutzler L, Protopsaltis T, Bendo J, Bosco J . Utilization of Lumbar Spinal Fusion in New York State: Trends and Disparities. Spine (Phila Pa 1976). 2016; 41(19):1508-1514. DOI: 10.1097/BRS.0000000000001567. View

Peterson A, Roache J, Raj J, Young-McCaughan S . The need for expanded monitoring of adverse events in behavioral health clinical trials. Contemp Clin Trials. 2012; 34(1):152-4. DOI: 10.1016/j.cct.2012.10.009. View

Herbert M, Tynan M, Lang A, Backhaus A, Casmar P, Golshan S . An integrated mindfulness meditation and acceptance and commitment therapy intervention for chronic pain: Rationale, design, and methodology of a pilot randomized controlled trial of Acting with Mindfulness for Pain (AMP). Contemp Clin Trials. 2022; 119:106809. DOI: 10.1016/j.cct.2022.106809. View

Hruschak V, Cochran G, Wasan A . Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature. J Opioid Manag. 2018; 14(5):345-358. DOI: 10.5055/jom.2018.0467. View

Jamison R, Jurcik D, Edwards R, Huang C, Ross E . A Pilot Comparison of a Smartphone App With or Without 2-Way Messaging Among Chronic Pain Patients: Who Benefits From a Pain App?. Clin J Pain. 2016; 33(8):676-686. PMC: 5443703. DOI: 10.1097/AJP.0000000000000455. View

Wetherell J, Afari N, Rutledge T, Sorrell J, Stoddard J, Petkus A . A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011; 152(9):2098-2107. DOI: 10.1016/j.pain.2011.05.016. View

Desai M, Jonely H, Blackburn M, Wanasinghage S, Sheikh S, Taylor R . The Back Pain and Movement (B-PAM) registry; a study protocol. BMC Musculoskelet Disord. 2019; 20(1):249. PMC: 6533756. DOI: 10.1186/s12891-019-2625-x. View

Rickardsson J, Zetterqvist V, Gentili C, Andersson E, Holmstrom L, Lekander M . Internet-delivered acceptance and commitment therapy (iACT) for chronic pain-feasibility and preliminary effects in clinical and self-referred patients. Mhealth. 2020; 6:27. PMC: 7327284. DOI: 10.21037/mhealth.2020.02.02. View

10.

Rolving N, Nielsen C, Christensen F, Holm R, Bunger C, Gregersen Oestergaard L . Does a preoperative cognitive-behavioral intervention affect disability, pain behavior, pain, and return to work the first year after lumbar spinal fusion surgery?. Spine (Phila Pa 1976). 2015; 40(9):593-600. DOI: 10.1097/BRS.0000000000000843. View

11.

Althaus A, Arranz Becker O, Moser K, Lux E, Weber F, Neugebauer E . Postoperative Pain Trajectories and Pain Chronification-an Empirical Typology of Pain Patients. Pain Med. 2018; 19(12):2536-2545. DOI: 10.1093/pm/pny099. View

12.

McCracken L, Sato A, Taylor G . A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results. J Pain. 2013; 14(11):1398-406. PMC: 3824075. DOI: 10.1016/j.jpain.2013.06.011. View

13.

Turk D, Rudy T . Neglected topics in the treatment of chronic pain patients--relapse, noncompliance, and adherence enhancement. Pain. 1991; 44(1):5-28. DOI: 10.1016/0304-3959(91)90142-K. View

14.

das Nair R, Mhizha-Murira J, Anderson P, Carpenter H, Clarke S, Groves S . Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial. Clin Rehabil. 2018; 32(6):777-789. PMC: 5987849. DOI: 10.1177/0269215518755426. View

15.

Khalifeh J, Dibble C, Hawasli A, Ray W . Patient-Reported Outcomes Measurement Information System physical function and pain interference in spine surgery. J Neurosurg Spine. 2019; 31(2):165-174. DOI: 10.3171/2019.2.SPINE181237. View

16.

Travaglini L, Highland K, Rojas W, Buckenmaier C, Kent M . Identification of Functioning Domains in the Presurgical Period and Their Relationships with Opioid Use and Pain Catastrophizing. Pain Med. 2018; 20(9):1717-1727. DOI: 10.1093/pm/pny246. View

17.

Devilly G, Borkovec T . Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000; 31(2):73-86. DOI: 10.1016/s0005-7916(00)00012-4. View

18.

Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M . Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017; 166(7):493-505. DOI: 10.7326/M16-2459. View

19.

Kang E, Chen J, Foster E . Feasibility and Implementation Determinants of a Structured Goal Setting and Goal Management System. Am J Occup Ther. 2023; 77(6). PMC: 10846417. DOI: 10.5014/ajot.2023.050296. View

20.

Azam M, Weinrib A, Montbriand J, Burns L, McMillan K, Clarke H . Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service. Can J Pain. 2022; 1(1):37-49. PMC: 8730651. DOI: 10.1080/24740527.2017.1325317. View